When Your Healthcare Claim Is “Denied”

You have Health Care Insurance – CHECK

You saw your Doctor – CHECK

He wants to run some tests – CHECK

You try to get pre-approval of your tests – DENIED:(

You get the test anyway and submitted your insurance claim – DENIED!

Lost in the Health Care Debacle debate is the dirty little secret of the Health Care Industry. And, sadly, this has nothing to do with ObamaCare.  This game has been played for decades.  Your insurance company is NOT in the business of taking care of you.  They are in the business of spending less, not more, on your health care. So, they will routinely deny approval of medical tests that you and your doctor deem prudent, and they will routinely deny coverage for expenses that you have incurred.

Unfortunately, many people stop there! Effectively denied sometimes critical health care.

This is a numbers game.  The insurance companies know that if they deny 10 approval requests for claims, only one or two of those insureds will protest, appeal, re-apply and/or fight for the coverage they are entitled to.  In the end, the loud protestor gets the treatment and care they deserve.  The meek suffer what is effectively the de facto rationing of health care by your    own insurance company.

The link below is to a great article from Forbes that lays out the steps you can – and MUST – take to protect yourself and get the care to which you are entitled.

  • Find out WHY you were denied and determine if you can correct any of those reasons.
  • Recruit your health care providers to advocate on your behalf in pursuing approval of the denial.
  • Apply again, re-apply, appeal, protect and threaten to sue!
  • Keep complete and accurate records of everything.
  • Find out how much the denied care “really costs” and negotiate for the best, contract and discounted rate available.

It is hard to live in a world where you have to fight with everybody for everything, especially when you are sick or injured. But the Health Care System is not going to get easy or accommodating anytime soon.  It is a battlefield. Those that understand this and approach the consumption of health care with the right attitude and tools are among the few that will get the care and treatment that they want, need and deserve.

The 5 Things You Should Know When Your Healthcare Claim Is “Denied” – Forbes.